Impacts of Initial Prescription Length and Prescribing Limits on Risk of Prolonged Postsurgical Opioid Use.
Impacts of Initial Prescription Length and Prescribing Limits on Risk of Prolonged Postsurgical Opioid Use.
复制标题
初始处方长度和处方限制对长时间术后阿片类药物使用的风险的影响。
DOI：
10.1097/mlr.0000000000001663
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发表时间：
2022-01-01
期刊：
影响因子：
3
通讯作者：
Jonsson Funk M
中科院分区：
文献类型：
--
作者：
Young JC;Dasgupta N;Chidgey BA;Stürmer T;Pate V;Hudgens M;Jonsson Funk M
为了回应对手术后阿片类药物成瘾的担忧，许多州已经实施了限制最初术后处方供应天数的法律。然而，很少有研究检查与初始处方量相关的长期阿片类药物使用风险的变化。评估与初始阿片类药物处方长度相关的阿片类药物长期使用的风险以及处方限制的潜在影响。使用医疗保险索赔（2007 - 2017），我们确定了opioid-naïve接受手术的成年人。使用g计算方法和逻辑回归模型，我们估计了阿片类药物长期使用的风险（在手术后连续3个30天窗口中配发≥1张阿片类药物处方）与不同的初始供应天数相关。然后，我们估计与不同处方限制相关的长期阿片类药物使用病例的潜在减少。我们确定了1,060,596例opioid-naïve手术患者。在70.0%接受阿片类药物治疗术后疼痛的患者中，1.9%的患者长期使用阿片类药物。长期使用的风险从0.7%（1天供应）增加到4.4%（15天以上）。我们估计，4天的处方限制将使每千名患者的风险降低4.84(3.59,6.09)，并可能避免2255例长期使用。通常使用的每天7次的供应限制将与较小的风险降低相关（aRD=2.04[- 0.17,4.25] /千人）。手术后延长阿片类药物使用的风险随着处方持续时间的增加而单调增加。常见的以天数为基础的最大处方可能会影响许多患者，但与长期使用减少病例的数量相对较少有关。任何处方限制都需要与适当的疼痛管理进行权衡。
In response to concerns about opioid addiction following surgery, many states have implemented laws capping the days supplied for initial postoperative prescriptions. However, few studies have examined changes in risk of prolonged opioid use associated with the initial amount prescribed. To estimate the risk of prolonged opioid use associated with length of initial opioid prescribed and the potential impact of prescribing limits. Using Medicare insurance claims (2007 – 2017) we identified opioid-naïve adults undergoing surgery. Using g-computation methods with logistic regression models, we estimated the risk of prolonged opioid use (≥1 opioid prescription dispensed in 3 consecutive 30-day windows following surgery) associated with varying initial number of days supplied. We then estimate the potential reduction in cases of prolonged opioid use associated with varying prescribing limits. We identified 1,060,596 opioid-naïve surgical patients. Among the 70.0% who received an opioid for postoperative pain, 1.9% had prolonged opioid use. The risk of prolonged use increased from 0.7% (1 day supply) to 4.4% (15+ days). We estimated that a prescribing limit of 4 days would be associated with a risk reduction of 4.84 (3.59,6.09) per thousand patients and would be associated with 2,255 cases of prolonged use potentially avoided. The commonly used day supply limit of 7 would be associated with a smaller reduction in risk (aRD=2.04 [−0.17,4.25] per thousand). Risk of prolonged opioid use following surgery increased monotonically with increasing prescription duration. Common prescribing maximums based on days supplied may impact many patients but are associated with relatively low numbers of reduced cases of prolonged use. Any prescribing limits need to be weighed against the need for adequate pain management.